NotUrAvg

Hey Iceman, I just moved from Tampa last month, and was looking for consultations in the area. Like you I could not find good info on Summit. I did consult with Dr. Paul Rose in S. Tampa who is recommended by this site (which you probably already know). He seemed like a straight shooter, and pretty knowledgable. His pricing wasn't horrible either. I also know that Dr. Glenn Charles occasionally comes to Tampa for consultations even though he is based in Boca Raton I think. He is also very vetted, and a frequent contributor here on the site. You are probably in great hands with him too. When you consult with Summit, you at least have two other recommended docs in the area you can compare them to. Sorry I couldn't answer your question directly.

Hey Julius thanks for your response and shared curiosity. I had a visit with Dr. Path in his clinic yesterday, and was fortunate to catch him at the end of his surgical day so I was able to have a 30 minute conversation with him about oral minoxidil. I'm a physician and reluctant to take off-label medications when they could be potentially dangerous. However, after talking with Dr. Path I was not only convinced but excited to take it. He prescribes minoxidil 5mg PO once daily. It only has a 4 hour half life, so I don't know why he prescribes it once daily. He does not prescribe any accompanying diuretic or beta-blocker. He has twenty years of experience prescribing it to patients, and about fifteen years experience using it on himself. He states that the results of 5mg are definitely superior to 2.5mg. He has used the medication in a large number of patients, and has not seen any serious adverse reactions. He has written an entire chapter about it in "Hair Restoration Surgery in Asians" (not sure you can find that one in your local library) - Chapter 9 -Medical Treatment Including Herbs and the Unreported Use of Oral Minoxidil. He states that it potently promotes hair maturation, which could make miniaturized or vellus hairs mature to terminal hairs. This is very promising in MPB as many of the vellus hairs that are there are useless and probably doomed to fall out. Like topical rogaine, the results are reversed with cessation of the drug. Dr. Path states that stopping oral minoxidil is much more dramatic than stopping rogaine because the initial growth it caused is much greater. The main side effects he has seen are hirsutism and general growth of body hair (watch out unibrow). The fluid retention he has seen has come in the form of mild lower extremity edema and some puffiness in the face. In Thailand it's very cheap, but Dr. Path states that in the US it's something like $1000/month. I'm a little skeptical about that pricing, as epocrates suggests it maybe $20-30/month, but since i'm abroad I can't verify this. I ran into another of Dr. Path's patients from India who has been on the drug for 3 years (and swears by it), but states that he has to get it from Thailand. My 2 cents. This is a very exciting prospect for me. I know that one HT session isn't going to be enough for me, but with this medication I'm adding a new weapon to the armamentarium against hair loss and towards regrowth. And a very powerful one at that. Like many others who have progressed to needing surgical treatment for MPB, I have been resigned to the limitations of medical treatments such as rogaine and propecia even though they are quite necessary to prevent further loss. No matter how effective they are, it is almost impossible to achieve adequate cosmetic results from medical therapy alone with advanced hair loss. However, Dr. Path made it sound like with oral minoxidil this was possible. He states he has patients he has turned down as surgical candidates because their hair loss was too advanced and donor area too small, and ended up prescribing them oral minoxidil. He states that when they return,. he has been shocked numerous times at the hair growth. However, that being said, I think that using it has to be approached with caution. I have not seen good prospective studies looking at this dosage for hair loss. I don't know the therapeutic index which is extremely important for determining whether a medication is safe to take based on side effects. The side effects can be severe - tachycardia, arrthymia, and pericardial effusions. . However, there is no good data to suggest that these side effects are seen with 5mg doses. And even if they are, they may be in such small percentages it may not be worth worrying about. Even aspirin can theoretically cause aplastic anemia and Reye' syndrome (very lethal) which doesn't stop people from taking it. If it is so effetive, it makes you wonder why it is not approved by the FDA for hair loss. But asking yourself a question like that is useless because most reasons are financial or political and not related to safety. In medicine, when there are no good studies, the next best thing to look at is physicians' experiences. As far as credibility and experience, there are few who are up there in caliber with Dr. Path. So for me, it's an issue of trust, and if he recommends it for me, then yes, I trust him. I doubt you will be able to find a doctor in the US willing to prescribe the medication. Not because they have any knowledge about it's use or safety, but because they don't want to take on the unnecessary liability in giving a drug they have no experience in using, especially in a very litigious medical environment. In my opinion (I'm no cardiologist), I don't think it would be prudent to use this if anyone has any history of heart problems or arrythmias. If someone is on other antihypertensives, it's use should be monitored very closely, as to avoid orthostatic hypotension. But Dr. Path did not state that I should be monitored by a physician when I use it, so I don't know if he requires it's use to be monitored. I am young though without any other medical conditions, so I feel a little safer using it. Anyways, I'm very sorry for rambling on. I hope this discussion will be found useful to others. I would love to hear the opinion of any HT docs and any patients who have used oral minoxidil.

I don't mean to contradict wb280, but Dr. Path is willing to proceed without shaving though he doesn't prefer this. WB280 must not have been and persistent and irritating as I was =) But it does make things harder for them. Dr. Path suggested it made my surgery 1-2 hours longer because he didn't shave. IMO, he did an excellent job putting in the grafts with my native hairs in place.

Future_HT_Doc, You are thinking exactly along the same lines I am. I would love to know if it outweighs topical minoxidil. In theory systemic medications have higher concentrations and better distribution due to circulation in the blood stream. But whether this translates to actual higher potency and efficacy I don't know. According to Dr. Path, he thinks the low dose of oral minoxidil has much better results than topical minoxidil, with a low side effect profile. I wish there was a good double blind prospective study, but I guess I have to rely on anecdotal experience. I wish there were other doctors on this forum who have had some experience with prescribing lose dose minoxidil. Maybe in your residency, Future, you can design this study and make some mullah (not that you won't be rich as a HT doctor as it is). Thanks for your input! =)

Hey Keith, day 3 is going great. I specifically updated my log today for you so that you could see the swelling and how I've been covering my head. Ultracet is cheap and you don't need a Rx in Thailand so I've been taking it every 8 hours without any pain. If I wait too long, I do get some pain (I avoid opioids since I'm a lightweight). I started taking 10mg of prednisone today based on what Goldilocks said on this forum (I figured it's a low dose and after 3 days it won't retard healing too much and can only help with the swelling). I also slept at a 45 degree angle with an airplane pillow around my neck for the first 3 nights. Maybe it helped with the swelling, and it definitely helped me prevent rubbing my donor and recipient area against the pillow. My HT doc, said there was no problem wearing a hat as long as the headband is on, minimizing direct contact. Just be careful to place the hat on from the top and remove it the same way so you are not rubbing the grafts. I've been wearing a hat over my band since day 1 and have been meticulously checking for dislodged grafts and have yet to see any. I'm getting my sutures removed (interrupted nylon with a running vicryl were used - not staples), on day 5 here in Thailand. I'm very lucky that I'm able to take a month to travel and recover in Southeast Asia before I head back to the US. Each person's experience is different and I'm sure there is a chance you may feel lousy immediately after, but I've been feeling pretty great. I spent the whole day shopping, eating and watching movies in Bangkok, and plan to head to Laos this weekend. But then again I did sleep 19 hours after I got home from the surgery. Hair Restoration Site for Not Ur Avg

Thank you Future_HT_Doc for the link to the blog. That discussion however was on Loniten which is the 10mg form of systemic minoxidil. I may have neglected to mention that the dosage prescribed to me was lower, maybe 1 or 2mg, thus mitigating the risks of more serious systemic side effects (Kind of like taking 1mg finasteride instead of 5mg). I don't know if there have been good head to head studies (excuse the pun) comparing it with topical minoxidil. I would love to hear your experience RCWest regarding hair growth and side effects.

I could not find a really relevant thread covering this topic. I just had a HT this week in Thailand and agreed to start taking oral minoxidil. I picked up a 1 year supply (it's cheap here in Thailand). The doctor stated that in his experience he has noted excellent results from systemic use of the medication including good growth on the crown (far superior to topical use of minoxidil). He stated that the dosage prescribed is low that systemic side effects are negligible. The main problem was general growth of body hair. Unfortunately I could not find any good information on people's experiences with this drug, and it's therapeutic index or protective index for use with hair loss (pharmaceutical terms describing how efficacious the drugs are without causing serious side effects). I would like to know if there is anybody out there using or prescribing oral minoxidil. Will I end up looking like Cousin It? And yes, I already know it was used historically for hypertension and hair growth was found as a serendipitous side effect. Any advice would be greatly appreciated! Thanks!

Hey Keith, I have VERY novice advice to offer, since I'm only 3 days post-op. I traveled from the US to Thailand for the surgery in order to make a vacation out of my recovery, and to keep things inconspicuous. I'll know better in a few days when the swelling has been the worst, but on post op day 1 I had almost no swelling at all, and day 2 I had a bit on the recipient area. I had about 3600 grafts. The only advice I can confidently give is to wear an elastic sweat band around your head. My HT doctor has all his patients do this to prevent any of the edema from creeping down onto the face and eyelids. When I remove the band I can definitely see that the edema stops right where the band is, and my face looks normal as ever (though the top of my head is slightly melonous). On the first post op day I had no problem taking public transit and hanging out at the mall. I've been meandering around bangkok since the surgery, of course keeping my head covered, and minimizing my time in the heat. Prednisone is probably a good idea to prevent swelling, and I may pick up some tomorrow (though in theory this may retard healing). I'm enjoying my vacation very much and the pain has been controlled with ultracet q8 hours. My experience is only anecdotal but I hope it helps.

Thank you both for the reply. I have emailed Dr. Path, whose office seemed to downplay the situation, stating it did not affect things too much. However, the situation still leaves me a little apprehensive. Most people who have seen Dr. Path in the past recommended taking the BTS train, but the train was bombed 2 weeks ago. There is an element of domestic terrorism in that country, and they have time and again proven to target areas frequented by tourists (even though tourists themselves don't seem to be their direct targets). As I haven't booked my flight yet, I have yet to plan the specifics of where I was staying. But given to risk of heavy traffic, and the unpredictability of BTS, I was thinking about staying walking distance from the office if that was possible. Thank you again monkey, it helps to hear the opinions of people who are there!

So I am scheduled for my first HT in 6 weeks from Dr. Pathomvanich in Bangkok, and was wondering if there is any update from anyone who has gone over there within the past 4 weeks. There were a few frequent posters who were supposed to have gotten there surgery there recently. I have PM'd them but have yet to get a response. The Red Shirt situation is getting me a bit nervous, and I'm considering getting a refund of my deposit and going for a local guy in Florida. Any news from someone recently in BKK would be greatly appreciated.